A Disease by Any Other Name

About one in three U.S. adults is obese and about 18% of children (ages six through 19) also fall into this category (1, 2). This doesn’t even count those who are overweight. Hardly anyone will disagree that obesity is a serious problem in the United States. But, is the answer to classify obesity as a disease?

Disease Claim of a Different Nature

Check out this month’s news story (p. 8) about some new policies adopted by the American Medical Association (AMA) at its Annual Meeting. While AMA policy is not the law of the land, the medical group is so large and powerful that its stance on health issues is far-reaching, with the potential to influence everything from the care a patient receives to his/her medical options to the coverage of it all by insurance companies.

At its recent meeting, AMA announced that it now considers obesity a disease. This means doctors are now encouraged to talk about obesity treatments with patients and AMA will work with insurance companies to cover such services.

This may sound well and good, but I’m not convinced such labeling is the best route for addressing this serious issue. First off, what AMA means by “treatment” is likely bariatric surgery and drugs. It’s a clear green light to drug companies that they can safely develop obesity drugs while AMA members wait in the wings with their prescription pads at the ready, eagerly awaiting marketing approval. Before long, the U.S. Food and Drug Administration (FDA) surely will be flooded with requests to approve pills that promise to reduce fat in a few weeks, regardless of the side effects.

Dangerous Side Effects

The most hazardous repercussion could well be one that you’d never see on a drug’s black box warning. Labeling obesity as a disease is a decisive blow in a battle over the semantics of weight and health. Overnight, patients have become “ill” and their excess body weight is now defining their fate. Thus, quick fixes like drugs and surgery are now essential, and you can bet your bottom dollar that patients will be pressured into choosing one of these options.

Likely left out in the cold will be talk of diet, exercise and, heaven forbid, dietary supplements to address healthy weight from a nutritional standpoint. I guess this route isn’t profitable for the medical community, so it’s not worth the time and effort.

The decision to focus on obesity as a disease is even more troubling given a recent AMA report indicating that “a number of research studies report no effect—or even slightly protective effects—of overweight and obesity on mortality risk (i.e., J- or U36 shaped associations)” (3). Why? A diagnosis of obesity is very often based on body mass index (BMI), which doesn’t always paint a complete picture of one’s health or even one’s body mass. Numerous factors contribute to obesity, and it’s a shame that AMA is putting such a strong emphasis on BMI, drugs and surgery, and so little on overall healthy living.

The medicalization of obesity seems financially motivated, with the powerful medical/pharmaceutical community in mind. And, given that obesity is based on an easily shiftable measurement like BMI, I wonder whether we’ll see the criteria for obesity (BMI of more than 30) slowly drop to include others under the umbrella to maximize profits.

What would be a better prescription for the problem would be a commitment from AMA to better understand the nutritional links to health (including weight loss). This includes “controversial” topics like healthy fats, the cholesterol paradox and supplements that support a healthy weight. Until then, I guess AMA will continue to improve outcomes—for the wrong people. WF